Go Ask Your Patients! PSS-QoL Reported Perception of Dryness Correlates With Lacrimal and Salivary Flow in Primary Sjögren's Syndrome

Introduction/Objectives: The patient perspective is an essential outcome parameter in the quest for effective therapy in primary Sjögren's Syndrome (PSS). The EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI) is recommended by EULAR to quantify patient's symptom burden and has been used in several clinical trials. Surprisingly, the patient's perception of dryness quantified with ESSPRI does not correlate with objective measures of salivary or lacrimal flow. Thus, we evaluated a newly developed assessment tool-the Primary Sjögren's Syndrome Quality of Life Questionnaire (PSS-QoL)-for quantifying symptoms of dryness in comparison with the ESSPRI and objective measurements of salivary and lacrimal flow. Methods: Data of patients from the PSS registry of the Medical University of Graz fulfilling the 2016 ACR/EULAR classification criteria for PSS were analyzed. The patient perspective was analyzed by PSS-QoL, ESSPRI, Xerostomia Inventory (XI) and Ocular Surface Disease Index (OSDI). Sicca signs were measured with Schirmer's test, unstimulated salivary flow test (USF) and stimulated salivary flow test (SSF). ESSDAI (EULAR Sjögren's Syndrome Disease Activity Index) and EGA (Evaluator Global Assessment, numeric rating scale from 0 to 10) were obtained. In addition, free light chains (FLC) κ and λ, rheumatoid factor (RF) IgM and IgA were determined. Results: Data from 123 PSS patients were analyzed; 91.9% (n = 113) were female, with a mean disease duration of 6.2 (±5.3) years and mean age of 60.1 (±12.4) years. PSS-QoL-dryness revealed significant negative correlations with Schirmer's test (r = -0.31, p < 0.05) and SSF-test (r = -0.390, p < 0.01). In contrast, we found no significant correlation between ESSPRI-dryness and any objective dryness test. Lower perceived dryness was associated with higher immunological activity determined by increased levels of IgG, FLC and RF-IgA. Whereas patients with only subjective signs of dryness had lower immunological activity. Discussion: Patients' perception of dryness assessed by PSS-QoL correlates with objective measurements of salivary gland function while ESSPRI-dryness did not. Based on the PSS-QoL and objective measures of dryness two distinct groups of PSS patients could be distinguished, which may have implications in daily practice and future clinical studies.

Demodex Mite Infestation and its Associations with Tear Film and Ocular Surface Parameters in Patients with Ocular Discomfort

PURPOSE

The presence of Demodex species can be associated with blepharitis. Their pathogenic potential in meibomian gland dysfunction is discussed herein. The purpose of this study was to determine the prevalence of Demodex mites in eyelashes of Austrian patients with ocular discomfort and to evaluate associated changes of the lid margins and meibomian glands.

DESIGN

This is a case-control study.

METHODS

Two hundred twenty-nine consecutive patients with ocular discomfort from an Austrian dry eye clinic were investigated for the presence of Demodex mites on sampled eyelashes. Associations of a mite infestation with individual dry eye and lid parameters were assessed. Lid margins were evaluated for scales, vascularization, Marx line, expressibility and quality of meibum, and drop-out of meibomian glands.

RESULTS

Demodex mites were identified in 40.2% of patients suffering from ocular discomfort (mean mite count 3.3 ± 2.9 per patient). Infestation with mites was associated with the presence of significantly more cylindrical scales (sleeves), a higher Marx line score, and a lower quality of meibum compared with mite-free patients. There were no significant associations with the expressibility and the drop-out of meibomian glands.

CONCLUSION

The prevalence of Demodex mites in patients with ocular discomfort is high. The mean mite count per patient in this Austrian dry eye unit population is lower compared with previously published data from Asian regions. The infestation of the eyelids with Demodex species is associated with changes of the anterior and posterior lid margin, suggesting a pathogenic role in blepharitis and meibomian gland dysfunction.

The influence of electromagnetic radiation on the measurement behaviour of the triggerfish® contact lens sensor

BACKGROUND

To assess a possible signal drift, noise and influences of electromagnetic radiation on the measurement behaviour of the Triggerfish® contact lens sensor, which might be mistaken as IOP fluctuations.

METHODS

Contact lens sensors (Triggerfish®, SENSIMED AG, Lausanne, Switzerland) were fixed in a water bath. To reduce any external electromagnetic impulses, all plugs were removed from the sockets, no lights were switched on and no electronic devices, except a temperature logger were left in the test room. For 24 h signal drift, noise and the influences of a cordless telephone (Ascom d43 DECT Handset, EU DECT 1880-1900 MHz, Ascom Wireless, Baar, Switzerland), a smartphone (Sony Xperia Go ST27i, Sony Corporation, Tokyo, Japan) and a computer (Hewlett-Packard ProBook 650 15,6″ - D9S33AV, Hewlett-Packard Inc., Palo Alto, USA) on the measuring profile were analysed.

RESULTS

Twenty-four-hour measurements without provoked external electromagnetic impulses yielded a profile without any signal drift and 8.2 mV eq noise. During the activation of the cordless telephone a maximum measurement variation of 3.2 mV eq. (4.1-7.3), smartphone 1.8 mV eq. (4.7-6.5) and computer 1.4 mV eq. (6.3-7.7) were observed.

CONCLUSIONS

During 24-h measurements there was no signal drift and a very low noise. Patients concerned about electronic devices possibly interfering with the measurements of the contact lens sensor, can be informed, that the use of their cordless telephone, smartphone or computer does not cause any problems. The amount of the signal noise might help to define actual IOP fluctuations. Temperature fluctuations might influence the measuring profile.

Extracts of different pollen species and their effect on human tear fluid and an epithelial cell line

PURPOSE

Hazelnut and birch pollen are known to destroy tear film components and attack ocular surface cells. We investigated further pollen species from different plant families, whether they show similar effects on human tear fluid and an epithelial cell line in vitro, to provide a broad basis for further research on pollen reactions affecting the tear film and ocular surface.

MATERIALS AND METHODS

Regional pollen species from different plant families (Adoxaceae, Betulaceae, Fagaceae, Juglandaceae, Malvaceae, Oleaceae, Pinaceae, Plantaginaceae, Poaceae, Salicaceae, Sapindaceae) were collected. Their proteolytic activity was evaluated by Zymography. Human tear fluid and cells of an epithelial cell line were incubated with pollen extracts. Tear fluid was analyzed by Polyacrylamide gel electrophoresis (PAGE). Cytomorphology was assessed microscopically and cell viability by proliferation (MTS), water-soluble tetrazolium (WST-1) assay and the impedance-based xCELLigence real-time analysis (RTCA).

RESULTS

Zymography revealed significant protease activity and PAGE showed the degradation of tear proteins by different pollen species. Cells incubated with pollen extracts presented dose- and time-dependent cytomorphological changes. MTS, WST-1, and RTCA revealed cytostatic as well as cytotoxic effects of pollen extracts.

CONCLUSIONS

Pollen species from different plant families exert proteolytic activity and degrade human tear fluid as well as epithelial cells, which may play a crucial role in the pathogenesis of allergic and non-allergic reactions affecting the ocular surface.

The prevalence of meibomian gland dysfunction, tear film and ocular surface parameters in an Austrian dry eye clinic population

PURPOSE

The purpose of this study was to assess the prevalence of meibomian gland dysfunction (MGD) and its association with tear film and ocular surface parameters in an Austrian clinical population of dry eye patients.

METHODS

The records of 1372 consecutive patients from a dry eye unit were analysed retrospectively. Symptoms and objective tear film and ocular surface parameters were evaluated. Patients were classified into pure MGD, pure aqueous tear deficiency (ATD), MGD combined with ATD, pure anterior blepharitis (AB), Sjogren's syndrome (SS) without MGD and SS together with MGD.

RESULTS

Nine-hundred and sixty-five patients, that is 70.3% of the investigated population, mean age 55.4 ± 16.6 years, had signs of MGD. Of these, 684 (70.9%) were female. The intensity of symptoms did not differ between subgroups. Four hundred and ninety (50.8%) MGD patients had Schirmer test values ≤10 mm/5 min. The fluorescein break-up time and Schirmer test values were significantly higher in the pure AB and MGD group. The pure MGD group showed a significantly lower fluorescein staining of the cornea compared to the other groups, except for pure AB. Lissamine green staining of the ocular surface was present in all groups, but was at least pronounced in the pure MGD and AB group.

CONCLUSION

Meibomian gland dysfunction is a major cause of ocular discomfort and could often be found in combination with a reduced aqueous tear secretion. Although the intensity of subjective complaints was similar to all other subgroups, pure MGD exhibited the lowest severity of signs of ocular surface damage and also affected younger people.

Decreased viability and proliferation of CHANG conjunctival epithelial cells after contact with ultraviolet light-irradiated pollen

CONTEXT

Contact with pollen is the major reason for the development of allergic symptoms on the ocular surface leading to a significant increase of allergic diseases worldwide. Environmental changes such as increased ultraviolet (UV) radiation and air pollution are discussed as contributory causes for this increase.

OBJECTIVE

We investigated the effect of UV light on the histamine content of pollen and examined if an irradiation of pollen affects the viability and proliferation of conjunctival cells.

MATERIALS AND METHODS

Alder (Alnus glutinosa) and hazel (Corylus avellana) pollen were irradiated for different time periods with sunlight, UV-A or UV-B light and the histamine content was analysed and compared with non-irradiated pollen. Conjunctival epithelial cells (CHANG cells) were exposed to irradiated and non-irradiated pollen followed by an assessment of cell viability with the colorimetric MTS test and the impedance-based measurement of cell proliferation using the xCELLigence real-time analysis system.

RESULTS

UV light irradiation increased the histamine level of alder and hazel pollen in a dose-dependent manner. CHANG cells treated with irradiated pollen induced a statistically significant higher decrease of cell viability than treatment with non-irradiated pollen.

DISCUSSION AND CONCLUSIONS

Our results indicate that UV light is able to alter pollen thus making them more harmful for conjunctival cells.

Role of the vitamin K epoxide reductase complex subunit 1 (VKORC1) -1639G>A gene polymorphism in patients with retinal vein occlusion

PURPOSE OF THE STUDY

Retinal vein occlusion (RVO) is a major vision-threatening disease. Vitamin K epoxide reductase recycles reduced vitamin K, which is essential for the gamma carboxylation of clotting factors II, VII, IX, X and proteins C and S. Recently, the vitamin K epoxide reductase complex subunit 1 (VKORC1) -1639G>A (rs9923231) polymorphism has been reported as a novel risk factor for RVO in a Turkish population. The present study was set to confirm or to refute this association in a larger cohort of patients with RVO.

MATERIALS AND METHODS

The present case-control study comprised 285 patients with central RVO, 401 patients with branch RVO and 333 control subjects. Genotypes of the VKORC1 -1639G>A polymorphism were determined by 5' exonuclease assay (TaqMan).

RESULTS

No significant differences in either genotype distributions or allele frequencies of the vitamin K epoxide reductase complex subunit 1 -1639G>A polymorphism were found between patients and control subjects (p > 0.05). In a logistic regression analysis neither branch nor central RVO was predicted by the vitamin K epoxide reductase complex subunit 1 -1639G>A genotypes, but by arterial hypertension, ever-smoking status and in case of central RVO additionally by diabetes mellitus.

CONCLUSIONS

Our data suggest that the vitamin K epoxide reductase complex subunit 1 -1639G>A gene polymorphism is unlikely a major risk factor for patients with either central or branch RVO.